Sparrow Carson surgeries, for some patients, fraught with complications

Three former patients of surgeon Dr. Raymond Phillip Allard said they suffered from infections and pain following their knee surgeries at Sparrow Carson Hospital.
Beth LeBlanc / Lansing State Journal

Buy Photo

Donald Hacker discusses the impact of an infection following his July knee surgery at Sparrow Carson Hospital on Monday, Feb. 19, 2018 at his home in Six Lakes.(Photo: Beth LeBlanc/Lansing State Journal)Buy Photo

Each corner of his home in rural Six Lakes is filled with wood carvings of ducks, fishing knickknacks and silhouettes of pine trees. They now serve as reminders of his absence from outdoor pursuits.

A knee replacement in July and a subsequent infection has kept the 77-year-old sidelined for more than six months.

“When it comes to fishing and hunting, that’s my activities,” Hacker said, with a shrug. “I’ve never been laid up like this before.”

Hacker is one of several Sparrow Carson Hospital patients who reached out to the State Journal with concerns about their orthopedic surgeon.

Among their complaints: Complications, infections, repeat surgeries and near brushes with amputation.

Their orthopedic surgeon, Dr. Raymond Phillip Allard, is under investigation by the state because of infection complaints made by a nurse anesthetist at the hospital.

“He’s the boy that screwed it up,” Hacker said.

A little more than a week ago, Allard “voluntarily” gave up his physician privileges at Sparrow Carson, shortly after the federal agency Centers for Medicare and Medicaid Services announced Sparrow Carson’s Medicare partnership was at risk because of high infection rates. The hospital's CEO left days after Allard.

Hospital officials in November ended an employment contract with Jonnie Vanderhoef, the nurse anesthetist who reported the infection issues at the hospital. Vanderhoef filed a whisteblower lawsuit in February.

In a February letter to hospital employees, the hospital's interim CEO, Bill Roeser, characterized Allard's privileges at the hospital as "suspended" and instructed employees to call 911 if he was seen on the Sparrow Carson campus.

"Dr. Allard has every right to seek treatment in our Emergency Department for an injury or illness," Roeser wrote. "Otherwise, he is not permitted on any of Sparrow Carson Hospital's property."

Allard declined comment when reached by the State Journal Thursday.

He has his defenders. Among them is Robert Hoag, whose family has gone to Allard for multiple surgeries with no infections.

"Dr. Allard truly cares for his patients," Hoag said in an email. " He is one of the only physicians that treats his patients as he would his own family."

Best practices

On average, 0.5% of knee replacements statewide result in infections in the first 90 days, according to Dr. Brian Hallstrom, a clinical assistant professor at the Department of Orthopedic Surgery at University of Michigan.

There is little independent data to indicate whether or not Allard or Sparrow Carson eclipsed that percentage, but what is clear is that complaints about the hospital's infection control policies were enough to merit the attention of state and federal regulators.

Many of the patients who contacted the State Journal noticed their infections within 90 days of surgery, a good indicator that the infection was acquired at the hospital, said Hallstrom, who also is co-director of the Michigan Arthroplasty Registry Collaborative Quality Initiative, a quality care improvement group for hip and knee replacements.

“There’s obviously some element of bad luck that can happen and there’s patient factors that can affect infection rate,” Hallstrom said. “But really the infection rate should be below 1%.”

Reliable statistics for infection rates for individual surgeons are not available, Hallstrom said. However, some studies have pointed toward a higher complication rate among hospitals or individual doctors who perform fewer surgeries.

“I always tell people that they should go to someone who does a lot of the procedure, again because of that volume issue,” Hallstrom said.

In a statement Thursday, Ilene Cantor, vice president for marketing and communications at Sparrow, said officials started a review of "the reporting and documentation process" at the hospital, made leadership changes, and implemented additional infection control procedures after becoming aware of concerns there on Feb. 13.

“We remain focused on resolving this matter expediently and thoroughly, and are committed to the delivery of safe, high quality care and practices for our Carson patients, families and caregivers. As a system, Sparrow works tirelessly to ensure a culture that upholds the highest standards of patient care."

'Stunk like hell'

Buy Photo

Donald Hacker and his son Dennis Hacker discuss the impact of an infection following Donald's July knee surgery at Sparrow Carson Hospital on Monday, Feb. 19, 2018 from his home in Six Lakes.(Photo: Beth LeBlanc/Lansing State Journal)

Allard operated on Hacker on July 31 at Sparrow Carson Hospital, following months of knee pain that Hacker had managed through injections.

Hacker struggled with infection immediately after the surgery. After a fall in August, Allard operated again to fix the knee, scrape dead skin and install a skin graft.

By mid-September, the new skin had turned black and puss oozed from underneath.

Among the neat piles of medical records grouped on his dining room table is a stack of photos showing a progression of decay: Red, glossy skin is pinched together around a blackened patch and oozing sores; stitches stretch from one side of the knee cap to the other. “Stunk like hell,” Hacker said.

The blackened area likely indicated dead skin, an unexpected development following a surgery of this sort, Hallstrom said.

"You’ll often get a very thin scab that can be dark right along the incision line, but the skin should never turn black," he said.

On Sept. 16, Hacker’s son, Dennis, returned from Wyoming to help him. The father and son spent five weeks traveling to and from the hospital for intermittent cleanings of the wound.

At his father's appointment in early October, Dennis said, “Allard looked at him and said, ‘You’re about to lose that leg,’ and walked out of the room.”

“I wanted to smack him right then,” Donald Hacker said.

A few weeks after that incident, Donald Hacker decided to find a new hospital.

On Jan. 9, doctors at Spectrum Health Blodgett Hospital in Grand Rapidsremoved Hacker’s knee joint and replaced it with a spacer. He’s been in and out of rehab centers in Sheridan, Carson City and Lakeview for six months and there are no guarantees that he will keep his leg.

Hacker's case appears to be one of nine reviewed by state investigators when they determined the hospital did not have appropriate infection control procedures or documentation, according to a December 2017 LARA report in which Hacker is referred to as "Patient #13." The investigative report served as the basis for CMS's action against the hospital's Medicare partnership.

Though he has diabetes and gout, Donald Hacker said no surgery has sidelined him like the one at Sparrow Carson. He believes if the infection had been caught and treated earlier, he wouldn’t be facing the loss of his leg.

“He waited until it was on the bone and muscle and everything else,” Dennis Hacker said.

Buy Photo

Mari Wise, of Greenville, was a patient of Dr. Raymond Allard's when she contracted a staph infection following a total knee replacement. Wise is pictured in Greenville on Monday, Feb. 19, 2018.(Photo: Beth LeBlanc/Lansing State Journal)

'Nobody's taking my leg off'

Mari Wise used to be a dancer and a softball player. She figures the combination of the two were responsible for the bad knees that prompted a replacement in March 2014 at the age of 66.

Her surgery took place prior to Sparrow's acquisition of the hospital in 2015, when the facility was still known as Carson City Hospital.

A Greenville resident, Wise chose Allard because of his proximity at Carson City Hospital. She says she regrets the decision.

Six weeks after the surgery, her incision still wasn’t closing up. A blood test confirmed she had a staph infection in her leg.

Wise told Allard she didn’t want to go on vancomycin because of potential complications. She said he told her she may lose her leg.

“I said, ‘We can start here: Nobody’s taking my leg off and it’s not going to be you,’” Wise said in an interview in February.

Later, Allard drained, then restitched the wound.

‘When he closed it back up, it was a heinous looking suture,” Wise said. “I said, ‘I think I’m done.’”

A former nurse turned naturopath, Wise said she understands infections happen and are sometimes out of a doctor’s control.

Wise eventually kicked the staph infection on her own. But, in 2015, when the pain, swelling, and heat in her knee persisted, she went to Spectrum Health Blodgett Hospital in Grand Rapids. She was told her new knee was misaligned and hitting tissue instead of bone when she walked.

“The doctor had to take everything out and put it back in,” Wise said.

She’s had no complications after the 2015 operation at Blodgett, nor with a 2017 surgery to replace her second, right knee. But she still has no feeling on the bottom of her foot in her left leg.

Buy Photo

Judy and Donald Draher speak about the complications arising from Judy's 2012 knee surgery on Monday, Feb. 19, 2018, from their home in St. Johns.(Photo: Beth LeBlanc/Lansing State Journal)

'...A long hard road'

Within a week of her knee surgery in August 2012, Judy Draher, then 64, started complaining about heat near her surgery site.

In that same week, while physical therapists were at her home, Draher sat on her bed and her collateral ligament — which Allard said he had repaired during surgery — snapped in half.

The torn ligament prompted a second surgery that month in which Allard sewed the ligament together again and placed a skin graft over the opening.

Within days, Judy Draher’s skin became red and inflamed and the skin turned black. Photos of her wound are nearly interchangeable with those of Donald Hacker’s.

In September, Allard performed another surgery to remove dead skin. But the site remained red, hot and swollen for months afterward.

Eventually, the wound closed and Judy Draher was sent to physical therapy but therapists wouldn't work with her because her knee was so blistered and red, she said.

By April 2013, blisters were apparent on the back and front of Draher’s leg. She decided to go to a different doctor for treatment, who removed the knee joint, replaced it with antibiotic spacers and diagnosed her with the bacterial infection VRE.

“It’s an infection she’ll have for the rest of her life,” Donald Draher said. “She takes two antibiotics a day.”

“He told us this was going to be a long hard road,” Donald Draher said.

The new implant that Judy Draher received, called a hinged knee, allowed her to keep her leg but reduces the type of motion she can make. Falls on the knee are more likely, and have resulted in two broken ankles and a broken toe.

“This has completely changed my life 100%,” Judy Draher said. “I have pain in my leg all the time.”

Judy Draher, who also deals with diabetes, is currently involved in a class action lawsuit against the company that manufactured the prosthesis in her initial surgery. The lawsuit involves allegations regarding infection rates among patients with knee and hip replacements linked to the company.

Although they're involved with the suit, Donald Draher believes the infection was contracted at the hospital. Moreover, the Drahers believe Allard should have recognized the infection and treated it earlier and more aggressively.

“He let it go for all those months,” Donald Draher said.

“There was too much damage done from it being in there for so long,” his wife added.

Robert Hoag(Photo: Submitted)

'...do exactly what the doctor said'

While complaints mount against Allard, Robert Hoag feels obligated to come to his defense.

Allard has performed a total of 13 surgeries on the 54-year-old Crystal man, his wife and daughter. Among those surgeries, Hoag said he’s had three rotator cuff repairs, a carpel tunnel release, a knee scope and a total knee replacement.

Hoag, a former corrections officer, said he decided to go to Allard after watching him operate on an inmate.

He was impressed with Allard’s attention to detail then, and surprised by the recent allegations against the doctor.

“He gives very specific dos and don’ts on your post surgical care,” Hoag said. “He gives you very specific instructions on how to care for your wound and keep it clean.”

He said Allard’s concerns over cleanliness follow his patients to rehab. Hoag wondered whether those who experienced complications did so because of their own lack of care.